With a growing number of nurses and midwives on the receiving end of violent attacks in their workplaces, our ‘Stand up to Stop Violence’ campaign has launched with one clear objective:
To get agreement from the State Government to the principles underpinning the ‘10-Point Plan’ and to work with us to adapt and implement them across all public health care sites in South Australia as a matter of urgency.
Exploring the Ten-Point Plan
Point 1 - Improve Security
Who can argue that we need to improve security in SA Health workplaces? The nature and form, of course, will vary according to the circumstances but needs to include:
- Better training of staff engaged in security activities;
- Duress alarms that work;
- Consistent evidence-based allocation of resources towards improving security and safety;
- Use of technology and security personnel where that is appropriate;
- Consistent systems for checking personal belongings of visitors and patients;
- Secure areas for staff to retreat when necessary;
- Sound risk assessment and mitigation strategies.
Point 2 - Identify risks to staff and others
It would be remiss of any plan to address violence not to include strategies to mitigate the risks within each particular health care setting. Identifying these risks would, at the very least include the following strategies:
- Screening and assessing patients and others for risk of aggression or violence towards staff
- Fully integrating the violent and aggressive patient alerts system into the admission and patient stay process to ensure high-risk patients are identified and appropriately managed throughout their admission.
- Putting an escalation process in place to help staff seeking assistance from senior management to manage aggressive or violent behaviours.
- Ensuring sufficient numbers of nursing, medical and security staff are appropriately trained to respond to aggressive or violent behaviors.
- Implementing a process to allow for ongoing monitoring and evaluation of aggressive and violent behaviours and the risks to staff and others.
Point 3 - Include patients and their families
Including families in the development of patient care plans can help to identify at-risk behaviours, triggers and how to manage the behaviour. With that in mind, any plan to address violence and aggression should include:
- Developing Patient Care Plans in partnership with a patient and their family to identify care priorities, particularly if a high-risk of aggression or violence is identified .
- Developing management plans to identify triggers for aggression or violence with plan to manage the behaviour.
- Involving family members to ensure clear standards of behaviour are met.
Point 4 - Report, investigate and act
Reporting is a key component of any plan to address violence and allows for issues to be investigated and appropriate action to be taken. With this in mind, we would expect a plan to address violence and aggression in health care to require:
- The implementation of a structured process to investigate incidents in a consultative and collaborative manner;
- Health services to demonstrate clear and relevant action over incidents; and
- Health services to have a collaborative relationship with SA Police that assists staff to pursue their right to prosecution of offenders in a supportive manner.
Point 5 - Preventing violence through workplace design
Building modifications and designs must address the safety of staff and patients to prevent and support the management of aggressive and violent behaviours. This must be included in any plan to address violence and aggression in health settings, along with the reporting of environmental issues which have contributed to Code Black Emergency response calls or interfered in the Code Black team management of the aggressive or violent behaviour.
We would also expect the plan to require a SA Health Smoke Free Policy Directive to be available to staff and implemented across all sites with management plans in place for patients who are agitated and want to smoke in the smoke-free environment.
Point 6 - Provide education and training to health care staff
Incidents of violence and aggression cannot be managed without equipping staff with skills they need to appropriately and safely respond. As such, any plan to address violence in health care settings should provide for:
- Employer-specific training and education for both health workers and security staff;
- Ensuring all staff understand the level of educational needs to prepare for prevention and management of aggressive and violent behaviours; and
- Regular, multidisciplinary refresher training for health workers and security staff.
Overall, education about how to prevent and respond to aggression and violence should begin at the undergraduate level.
Point 7 - Incorporate legislation, policies and procedures
Any safety and security measures to protect staff should be integrated across all relevant laws, regulations and procedures. This should include:
- Ensuring the health service response to aggression and violence such as Code Black and Security Assist is consistent with state-wide policy; and
- Integration of violence prevention measures into other policies, such as clinical assessment, de-escalation, escalation, post-incident support, training and education, and security policies.
Point 8 - Provide post-incident support
Any staff member who has been on the receiving end of aggressive or violent behaviours should be provided with appropriate follow-up support. Such a process should be covered in a plan that truly aims to address violence and aggression in health care settings. At the very least, this process should provide for impacted to staff to receive:
- extensive and appropriate follow up;
- support and care;
- information about access to the workers’ compensation system; and
- information on, and support throughout, the police reporting system process.
Point 9 - Apply a consistent approach to violence
A strategic, measured approach to ending violence in health care needs to be embraced at all levels and across all disciplines of the health system. Such a planned approach should provide for:
- All workers in healthcare settings to expect they will not encounter violence or aggression at their workplace;
- All staff reports about aggressive or violent behaviour from a patient or a visitor to be taken into consideration when making decisions about the patient’s care and management; and
- The implementation of a clear model and process for regular, collaborative, multi-disciplinary case conferences for patients with challenging behaviors, with aggression and violence a specific consideration.
Point 10 - Empower staff to expect a safe workplace
The final step of any plan to end violence is just as critical as all of those preceding it. This step ensures a systemic plan that:
- Reflects management’s demonstrated commitment to a culture change whereby all health care settings take a ‘no acceptance’ approach to aggression or violence.
- Empowers staff to report incidents, implement preventative actions and believe in their right to a safe workplace.
- Allows for all action plans on the prevention and management of violent and aggressive incidents to be developed in consultation with staff.
How can you support this campaign?
Members and supporters are encouraged to stand up and make a difference to the safety and security of nurses and midwives across our public health care system by:
- Reporting* your experiences with violence – as they happen – via our new online reporting tool to help us shine a spotlight on the near-daily attacks on nurses and midwives. Note, de-identified versions of your experiences may be used in ANMF (SA Branch) communications to raise awareness of the frequency and impact of violence on nurses and midwives
- Actively promoting the campaign on-the-ground when action is planned at your workplace (a rolling schedule will occur – you’ll receive advice within 24-48 hours of when activity is planned in your unit/ward/area)
- Sharing information about this campaign with your family, friends and colleagues so the wider community understands why we need a plan to address violence now.
Sharing our posts on social media is a great way to keep loved ones informed of the facts around why you’re standing up for this cause, provided your social media profile is not linked to your workplace.
* Note: this portal SHOULD NOT replace or delay the reporting of violent incidents directly to your employer via the SLS system or other internal reporting processes.
Campaign communications channels
A range of campaign materials have been developed to ensure widespread awareness of the need for a plan to address violence in health care settings across South Australia.
- Radio advertisement
- Online reporting tool to shine a spotlight on the types of aggression and violent incidents you’re being subjected to every single shift.
- Social media
- Stickers for you to wear (on your front, back and sleeve) when the scheduled rolling action arrives in your workplace